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					                                 Adolescent Depression
                                 Issue #1                                           Winter 2006


                            Depression                            epidemiological studies show that
                            Every year, approximately 50 in       depression is a contributory factor
                            1,000 adolescents experience          to fatal coronary disease.9
                            the torment of major depression.1
                            Periods of anxiety or depression      The mood disorders that are most
                            during adolescence are common         often diagnosed in adolescents
                            and can be normal reactions to life   are major depressive disorder,
                            events.2 But, there is a difference   dysthymic disorder, and bipolar
                            between simply feeling depressed      disorder.10 The condition of major
                            over a life event and clinical        depressive disorder is a dire illness
                            depression. Clinical depression       identified by at least one MDE.11
        NEVADA KIDS COUNT




                            involves overwhelming feelings        About 2.2 million adolescents ages
                            of being sad for weeks or longer.3    12 to 17 (9 percent) languished
                            According to the Center for Mental    at least one MDE in 2004.12 A
                            Health Services, 12.5 percent of      teen with at least five signs or
                            teens endure clinical depression.4    symptoms of depression during a
                            The     mental-health     ailments    two-week period is having a MDE.
                            suffered by many adolescents          The symptoms of a MDE include
                            are being overlooked by busy,         a depressed or irritable mood;
                            distracted, or uninformed adults.5    diminished interest in almost
                                                                  all activities; sleep disturbance;
                            Among adolescents, aged 12            appetite disturbance; decreased
                            to 17 who reported having             concentration;      thoughts       of
                            suffered a major depressive           suicide or death; psychomotor
                            episode (MDE) in 2004, only           agitation or retardation; fatigue;
                            40.3 percent received depression      and feelings of worthlessness or
                            treatment within that time period.6   inappropriate guilt.13 Behaviors
                            Depressed teenagers are often         associated with a MDE include
                            “misdiagnosed, underdiagnosed,        the following: substance abuse
                            and undertreated.”7 Population        (self medicating), eating disorders
                            studies show that at any given        (such as anorexia), self injury
                            instance between 10 and 15            (such as cutting), and acting out
                            percent of the child and adolescent   (such as aggression).14 Once a
                            population endures symptoms of        young person has experienced a
                            depression.8 Predictions indicate     major depression, he or she is at
                            that depression may be the            risk of having a recurrence within
                            second largest killer after heart     five years.15
Center for Business         disease by the year 2020, and
        and
Economic Research
Dysthymic disorder is a mood disorder        23 percent smoked cigarettes, and
like major depressive disorder, but          roughly, 21 percent used drugs.21
it has fewer symptoms and is more
chronic.16 Bipolar disorder is a mood        Strategies need to be instituted to
disorder in which episodes of mania          reduce the stigma attributed to mental
alternate with episodes of depression.       illness and obtain treatment for those
The disorder normally begins with            afflicted.22 Upon diagnosis, there are
depression and the first manic                various treatment options for the
features may not occur for months            depressed individual. Medication was
or years after the first depressive           once the first treatment option, but is
episode.17 Manic symptoms include            not currently the preferred method.
difficulty sleeping; incessant talking,       Studies indicate that antidepressants
often rapidly or loudly; and racing          only work in 35 to 45 percent of the
thoughts. Manic adolescents may              population.23 The U.S. Food and
start numerous projects without              Drug Administration (FDA) issued
finishing them; engage in reckless            a public-health advisory in October
or risky behavior; or become                 of 2004 forcing manufacturers of
overconfident in their abilities.18           antidepressant drugs to display a
Twenty to 40 percent of adolescents          warning to alert medical professionals
with depression eventually develop           to the greater risk of suicidal
bipolar disorder. Reactive depression        thinking and behavior in children
is the most common mood problem              and adolescents being given these
in adolescents in reaction to minor          medications.24
adversities, which is not considered
a mood disorder.19                           Since medications are questionable,
                                             the most viable option would be
Some of the core symptoms of                 to address the underlying causes
depression, such as changes in               of depression instead of just the
appetite and sleep patterns are              symptoms.25 The other treatments
related to the functions of the              for depression involve therapy.
hypothalamus. The hypothalamus               The therapeutic treatments include
is, in turn, closely tied to the pituitary   the following: cognitive-behavioral
gland. Abnormalities of pituitary            therapy, group therapy, family therapy,
function, such as increased rates            and psychodynamic psychotherapy.
of circulating cortisol and hypo- or         Cognitive-Behavioral      therapy    is
hyperthyroidism, are well-established        based on the idea that emotions are a
features of depression.20                    learned response, the psychological
                                             pain is due to a person’s perception
The 2004 annual National Survey on           of what events mean to him/her.26 The
Drug Use and Health showed that              goal of cognitive-behavioral therapy
very depressed youth aged 12 to 17           is overturning pessimistic ways of
were twice more likely to engage in          thinking, creating social skills, and
substance abuse than those who               setting goals to pursue pleasurable
were not depressed. About 28 percent         activities   via     patient-therapist
of depressed teens used alcohol,             discussions. Group therapy involves


2
breaking down the feeling of isolation   accidents may actually be suicides
in the depressed adolescent, which       in disguise. Teen females attempt
can alleviate some of the depressive     suicide more frequently (about nine
symptoms by realizing they are           times more often) than teen males,
not alone in their experiences.27        but males are about four times
Family therapy addresses patterns        more likely to succeed when they
of communication in the family and       are trying to kill themselves. This
attempts to restructure the family in    is because teen males tend to use
order to provide a better support base   more deadly methods (like guns
for the patient.28 Psychodynamic         or hanging) than females who try
psychotherapy attempts to link           to hurt or kill themselves with less
symptoms of depression to childhood      deadly methods (like overdoses of
traumas or conflicts.29 Early traumatic   medications or cutting).37 In 2002,
experiences such as abuse or incest      an estimated 124,409 visits to U.S.
can manifest as depression; these        emergency departments were made
suppressed memories can emerge in        after attempted suicides or other self-
adolescence.30                           harm incidents among persons aged
                                         10-24 years.38 The most frequent
The simplest method for alleviating      method of suicide in this age group
depression may be physical exercise.     was by firearm (49%), followed by
Exercise causes the brain’s chemistry    suffocation (38%), and poisoning
to create more endorphins and            (7%).39
serotonin, which change mood.31
                                         The suicide risk among people with
Suicide                                  depression is about 30 times higher
Suicide is a permanent solution to a     than that of the general population.40
temporary problem (Phil Donahue).        “Four psychosocial factors were found
                                         to be important for overall suicide risk:
Over 90 percent of adolescents with      hopelessness, hostility, negative self-
suicidal tendencies have a treatable     concept, and isolation.”41 Suicide can
psychiatric disorder.32 Mood disorders   emanate from a depressed person’s
are major risk factors for suicide       feeling that life is so intolerable
among children and adolescents.33        that death appears to be the sole
Up to 15 percent of individuals          deliverance; the suicidal individual
diagnosed with major depressive          sees no opportunity for change
disorder die by suicide.34 An reported   or improvement.42 The suicidal
11 in 100,000 youth between the          individual cannot see beyond his/
ages 15 to 19 will attempt suicide       her depressive state symptoms. “In
each year and many more suicide          suicidal individuals dysregulation
attempts will go unreported.35 The       of the serotenogenic system is
third leading cause of death in 2002     common, making them impulsive,
was suicide in the 15 to 24 age          intense, and given to extreme
group; the first and second leading       reactions.”43 A hazardous period in
causes of death were accidents and       depression occurs when an individual
homicides, respectively.36 Some          is coming out of the deepest part


                                                                              3
of the experience and utilizes their      disorder among adolescent is major
newly acquired energy to take their       depressive disorder. Due to the
own life.44 It is not uncommon for an     suicide dangers associated with
individual to appear joyful prior to      current medications, adolescents
committing suicide.                       being treated by medication need
                                          to be monitored carefully. Therapy
The following behaviors are common        is preferred over medication, since
to someone who is suicidal:               the FDA warning in 2004. Since the
         Preoccupation with death;        majority of suicides occur among
         Statements of low self           individuals with treatable psychiatric
         esteem;                          disorders, it is paramount to identify
         A setting of affairs, such as    adolescents with these conditions
         possession of a will;            before it is too late. With education
         Giving away cherished            and awareness, suicide occurences
         possessions;                     can be reduced and perhaps moved
         Suicidal ideation;               down the list of leading deaths.
         Suicidal threats; or
         Suicidal-plan possession.45      References
                                          1. Bower, Bruce, August 2004, “Lifting the Mood,” Science
                                          News, Vol. 166, Issue 8.
Nevada
                                          2. Murphy, Kathryn, December 2005, “What Can You
According to the 2005 Youth Risk          Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12,
Behavior Survey (YRBS), 27.8              pp. 43-45.

percent of Nevada high school             3. Wysong, Pippa, December 2005, “Dark Moods,”
                                          Current Health, Vol. 32, Issue 4.
students felt so sad or hopeless
                                          4. Ibid.
almost every day for 2 or more weeks
                                          5. Shellenbarger, Sue, April 17, 2003, “Hiding from Your
in a row that they stopped doing          Teen’s Depression: Parents Struggle Over How to Cope,
some usual activities.46 In the past 12   Wall Street Journal, available online at: <http: //www.
                                          mdhealth notes.net/depression.htm> as of 1/23/06.
months, 16.1 percent of Nevada high
                                          6. Centers for Disease Control and Prevention, June 11,
school students seriously considered      2004, “Morbidity and Mortality Weekly Report,” Vol. 53,
attempting suicide.47 Close to nine       No. 22, available online at: <http://www.cdc.gov/mmwr
                                          /PDF/wk/mm5322.pdf> as of 1/25/06.
percent of Nevada high school
                                          7. Farmer, Terri J., 2002, “The Experience of Major
students attempted suicide one or         Depression: Adolescents’ Perspectives,” Issues in Mental
more times.48 In 2004, 19 percent of      Health Nursing, Vol. 23, pp. 567-585.
teen violent deaths (ages 15-19) were     8. Mental Health: A Report of the Surgeon General,
                                          “Depression and Suicide in Children and Adolescents,”
by suicide. Accidents were 61 percent     Ch. 3, available online at: <http://www.surgeongeneral.
and homicides were 20 percent.49          gov/library/mentalhealth/chapter3/sec5.html> as of
                                          2/1/06.

Conclusion                                9. LeBan, Levon A., Gladys Barrett-Merrick, and Robert
                                          Romanski, 1996, “Combating Adolescent & Teen
The condition of clinical depression      Suicide,” The Crisis Institute, Suicidology, available
involves overwhelming feelings of         online at: < http://www.gnofn.org /~nocrisis/two.html>
                                          as of 1/20/06.
being sad for weeks or longer. Many
                                          10. Mental Health: A Report of the Surgeon General,
adolescents who suffer from clinical      “Depression and Suicide in Children and Adolescents,”
depression are unable to escape           Ch. 3, available online at: <http://www.surgeongeneral.
                                          gov/library/mentalhealth/chapter3/sec5.html> as of
their dark moods without treatment.       2/1/06.
The most often diagnosed mood


4
11. Ibid.                                                      29. Murphy, Kathryn, December 2005, “What Can You
                                                               Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12,
12. U.S. Department of Health and Human Services,              pp. 43-45.
Substance Abuse and Mental Health Services Administration,
2005, “9 Percent of Adolescents Experienced a Major            30. Ibid.
Depressive Episode in the Past Year, Survey Finds,”
                                                               31. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal,
available online at: <http://www.samhsa.gov /news/
                                                               July 2005, “Teen Depression: Signs, Symptoms, and
newsreleases/051229_teens.htm> as of 1/20/06.
                                                               Getting Help for Teenagers,” Helpguide.org, available online
13. Murphy, Kathryn, December 2005, “What Can You              at: <http://www.helpguide.org/mental/depression_teen.
Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12,         htm> as of 1/20/06.
pp. 43-45.
                                                               32. Murphy, Kathryn, December 2005, “What Can You
14. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal,      Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12,
July 2005, “Teen Depression: Signs, Symptoms, and              pp. 43-45.
Getting Help for Teenagers,” Helpguide.org, available online
                                                               33. Child Trends DataBank, 2003, “Teen Homicide, Suicide,
at: <http://www.helpguide.org/mental/depression_teen.
                                                               and Firearm Death,” available online at: <http://www.
htm> as of 1/20/06.
                                                               childtrendsdatabank.org/indicators/70ViolentDeath.cfm>
15. National Mental Health Association, September 1998,        as of 1/11/06.
“Clinical Depression and Children/Adolescents,” available
                                                               34. LeBan, Levon A., Gladys Barrett-Merrick, and Robert
online at: <http://www.nncc.org/Child.Dev/depress. html>
                                                               Romanski, 1996, “Combating Adolescent & Teen Suicide,”
as of 1/24/06.
                                                               The Crisis Institute, Suicidology, available online at: < http://
16. Mental Health: A Report of the Surgeon General,            www.gnofn.org /~nocrisis/two.html> as of 1/20/06.
“Depression and Suicide in Children and Adolescents,”
                                                               35. Ibid.
Ch. 3, available online at: <http://www.surgeongeneral.gov/
library/mentalhealth/chapter3/sec5.html> as of 2/1/06.         36. Child Trends DataBank, 2003, “Teen Homicide, Suicide,
                                                               and Firearm Death,” available online at: <http://www.
17. Ibid.
                                                               childtrendsdatabank.org/indicators/70ViolentDeath.cfm>
18. Ibid.                                                      as of 1/11/06.
19. Ibid.                                                      37. Nemours Foundation, May 2002, “Suicide,” available
                                                               online at: <http://www.kids health.org/teen/your_mind/
20. Ibid.                                                      mental_health/suicide.html> as of 1/20/06.
21. CNN.com, December 29, 2005, “Study: Major                  38. Centers for Disease Control and Prevention, June 11,
depression strikes 2.2 million U.S. teens,” available online   2004, “Morbidity and Mortality Weekly Report,” Vol. 53,
at: <http://www.cnn.com/2005/HEALTH/conditions/12/29/          No. 22, available online at: <http://www.cdc.gov/mmwr
health.depres sion.reut/?eref=yahoo> as of 1/20/06.            /PDF/wk/mm5322.pdf> as of 1/25/06.
22. Hyde, Toni, John Kirkland, David Bimler, and Pia
                                                               39. Ibid.
Pechtel, August 2005, “An Empirical Taxonomy of Social-
Psychological Risk Indicators in Youth Suicide,” Suicide and   40. National Mental Health Association, September 1998,
Life-Threatening Behavior, Vol. 34, No. 4, pp. 436-447.        “Clinical Depression and Children/Adolescents,” available
                                                               online at: <http://www.nncc.org/Child.Dev/depress. html>
23. Murray, Bob and Alicia Fortinberry, January 15, 2005,
                                                               as of 1/24/06.
“Depression Facts and Stats,” Uplift Program, available
online at: <http://www.upliftprogram.com/depression_stats      41. Rutter, Philip A. and Andrew E. Behrendt, Summer
.html> as of 1/20/06.                                          2004, “Adolescent Suicide Risk Four Psychosocial Factors,”
                                                               Adolescence, Vol. 39, No. 154, pp. 295-302.
24. Bridge, Jeffrey A., Rémy P. Barbe, Boris Birmaher, David
J. Kolko, and David A. Brent, 2005, “Emergent Suicidality in   42. Hyde, Toni, John Kirkland, David Bimler, and Pia
a Clinical Psychotherapy Trial for Adolescent Depression,”     Pechtel, August 2005, “An Empirical Taxonomy of Social-
American Journal of Psychiatry, Vol. 162, pp. 2173-2175.       Psychological Risk Indicators in Youth Suicide,” Suicide and
                                                               Life-Threatening Behavior, Vol. 34, No. 4, pp. 436-447.
25. Murray, Bob and Alicia Fortinberry, January 15, 2005,
“Depression Facts and Stats,” Uplift Program, available        43. Mental Health: A Report of the Surgeon General,
online at: <http://www.upliftprogram.com/depression_stats      “Depression and Suicide in Children and Adolescents,”
.html> as of 1/20/06.                                          Ch. 3, available online at: <http://www.surgeongeneral.gov/
                                                               library/mentalhealth/chapter3/sec5.html> as of 2/1/06.
26. Murphy, Kathryn, December 2005, “What Can You
Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12,         44. Soreff, Stephen, March 2005, “Suicide,” eMedicine,
pp. 43-45.                                                     available online at: <http://www.em edicine.com/med/
                                                               topic3004.htm> as of 1/20/06.
27. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal,
July 2005, “Teen Depression: Signs, Symptoms, and              45. LeBan, Levon A., Gladys Barrett-Merrick, and Robert
Getting Help for Teenagers,” Helpguide.org, available online   Romanski, 1996, “Combating Adolescent & Teen Suicide,”
at: <http://www.helpguide.org/mental/depression_teen.          The Crisis Institute, Suicidology, available online at: < http://
htm> as of 1/20/06.                                            www.gnofn.org /~nocrisis/two.html> as of 1/20/06.
28. Ibid.                                                      46. Nevada State Department of Education, Office of Child
                                                               Nutrition and School Health, Nevada Youth Risk Behavior
                                                               Survey, 2003, 2005.



                                                                                                                          5
47. Ibid.                                                                 Coping Strategies and Help-Seeking Behavior for
                                                                          Suicidality,” Journal of the American Academy of Child and
48. Ibid.
                                                                          Adolescent Psychiatry, Vol. 43, No. 9, pp. 1124-1133.
49. Center for Business and Economic Research, University
                                                                          57. Macgowan, Mark J., May 2004, “Psychosocial
of Nevada, Las Vegas, Nevada KIDS COUNT Data Book:
                                                                          Treatment of Youth Suicide: A Systematic Review of the
2006, by Rennae Daneshvary, R. Keith Schwer, William
                                                                          Research,” Research on Social Work Practice, Vol. 14,
Cope, Juliette Tennert, Robert Potts, and Freda Klein.
                                                                          No. 3, pp. 147-162.
50. Slattery, Ryan, January 20, 2005, “Report Card Gives
                                                                          58. Barbe, Remy P., Jeffrey Bridge, Boris Birmaher, David
Nevada Failing Grade in Several Child Welfare Categories,”
                                                                          Kolko, and David A. Brent, Spring 2004, “Suicidality and
Las Vegas City Life, available online at: <http://www.
                                                                          Its Relationship to Treatment Outcome in Depressed
lasvegascitylife.com/articles/2005/01/20/local_news/
                                                                          Adolescents,” Suicide and Life-Threatening Behavior, Vol.
news01.txt> as of 1/11/06.
                                                                          34, No. 1, pp. 44-55.
51. Young, Jami F., Kathy Berenson, Patricia Cohen,
                                                                          59. Fristad, Mary A. and Amy E. Shaver, 2001, “Psychosocial
and Jesenia Garcia, 2005, “The Role of Parent and Peer
                                                                          Interventions For Suicidal Children and Adolescents,”
Support in Predicting Adolescent Depression: A Longitudinal
                                                                          Depression and Anxiety, Vol. 14, pp. 192-197.
Community Study,” Journal of Research on Adolescence,
Vol. 15, No. 4, pp. 407-423.                                              60. U.S. Department of Health & Human Services, Office
                                                                          of Applied Statistics, December 30, 2005, “Depression
52. Sourander, Andre, Antti Haavisto, John A. Ronning,
                                                                          among Adolescents,” The NSDUH Report, available
Petteri Multimaki, Kai Parkkola, Paivi Santalahti, Georgios
                                                                          online at: <http://oas.samhsa.gov/2k5/youthDepression/
Nikolakaros, Hans Helenius, Irma Moilanen, Tuula
                                                                          youthDepression.htm> as of 1/20/06.
Tamminen, Jorma Piha, Kirsti Kumpulainen, and Fredrik
Almqvist, 2005, “Recognition of Psychiatric Disorders, and                61. Child Trends, 2003, “Adolescents Who Feel
Self-Perceived Problems. A Follow-Up Study from Age 8 to                  Sad or Hopeless,” available online at: <http://www.
Age 18,” Journal of Child Psychology and Psychiatry, Vol.                 childtrendsdatabank.org/indicators/30FeelSadorHopeless.
46, No. 10, pp. 1124–1134.                                                cfm> as of 1/20/06.
53. Sankey, Melissa and Ruth Lawrence, April 2005, “Brief
Report: Classification of Adolescent Suicide and Risk-
Taking Deaths,” Journal of Adolescence, Vol. 28, Issue 6,
pp. 781-785.
54. Scherff, Andrew R., Tanya L. Eckert, and David N. Miller,
April 2005, “Youth Suicide Prevention: A Survey of Public
School Superintendents’ Acceptability of School-Based
Programs,” Suicide and Life-Threatening Behavior, Vol.
35, No. 2, pp. 154-169.
55. Gutierrez, Peter M., Robin Watkins, and Dale Collura,
Winter 2004, “Suicide Risk Screening in an Urban High
School,” Suicide and Life-Threatening Behavior, Vol. 34,             By
No. 2, pp. 421-428.                                                  William Cope, MS, MBA
56. Gould, Madelyn S., Drew Velting, Marjorie Kleinman,              Faculty Consultant
Christopher Lucas, John Graham Thomas, and Michelle                  Center for Business and Economic Research
Chung, September 2004, “Teenagers’ Attitudes about                   University of Nevada Las Vegas




            If you need more specific information about the children
            and youth in your local area, contact Nevada KIDS
            COUNT, Keith Schwer, PhD, Director CBER or Rennae
            Daneshvary, PhD, Interim Nevada KIDS COUNT
            Coordinator, Assistant Director CBER
            Phone: (702) 895-3191
            Fax:      (702) 895-3606
            E-mail: kids@unlv.nevada.edu
                                                                   The Center for Business and
                                                                       Economic Research
                                                                4505 Maryland Parkway, Box 456002



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